Mission Health System COPD Readmission Data Cathryn C. Trimby, RRT, RCP Cathy.Trimby@msj.org Quality and Data Manager Six Sigma/Lean Certified Mission Health System Asheville, NC 28801

6 Member Hospital System Western North Carolina Tertiary Referral Center 708 Acute Beds and 62 BH Beds Level II Trauma Center Offer services to approximately 1M people in 18 counties Regional Transport Provider 3rd Busiest ED in North Carolina

COPD Readmission Rate Definition The number of Patients with a Principal Diagnosis of COPD that are readmitted for any cause to an acute care facility within 30 Days of a prior COPD index admission. Total number of Patients with a Principle Diagnoses for COPD for the time period Exclusion List- Transfers Admit Status- Elective Patients who leave Against Medical Advice

COPD: Care Process Model (CPM)

COPD Readmission Risk Factors Comparison Discharge period: July 1, 2014-June 30, 2017 Mission Patient Complexity Mission State National Eligible Discharges 964 30,694 852,039 Mean Age 74.8 75.7 76.7 Risk Factors Mission State National AMI 29% 30% CABG 24% 23% 25% HF 48% 50% 49% PN 56% 51% Stroke 4% 6% Vascular or Circulatory Disease 44% 41% Renal Failure 38% 36% 35%

COPD In Western North Carolina

MMH COPD Readmission Rate FY16 to FY18 Time Period Overall 30-Day Readmission Rate FY 17 15.75

Population Demographics Gender Race Age 66.7% Medicaid

Discharge Disposition Analysis DC Disposition mapped to Readmission

Readmission Demographics % Readmitted within 30 days LOS effects on readmissions Readmission post DC in Days % Readmissions 16 20 0 25 50 0 100 30

Mobile Integrated Health Mission Community CaraMedics Program Charles Blankenship, Manager Mission Health EMS Stace Horine, MD, Medical Director Randy Fugate Coordinator/Navigator

What is the Community CaraMedic Program? A program that uses certified community paramedics to operate in expanded roles within their scope of practice under the direction of a physician to provide in-home care to patients who are “at risk” due to a recent hospital discharge, chronic medical condition, or other significant factor. Filling gaps when other services are not available.

A well-structured, well-supported and high functioning department Medical Director - Medical administrator responsible for the oversight of community paramedic medical care and clinical services Coordinator / Navigator - Provides administrative services and dispenses procedures and policies; monitors work activities, projects and progress Care Manager – Responsible for enhancing the quality of care coordination, patient management throughout the continuum of care, and to assure cost-effectiveness of care Community CaraMedic - Supports existing health services; provides integrated health services in partnership with other health professionals; extends access to health services in underserved and general populations, including primary care, public health, disease management, prevention and wellness, mental health, and dental health; and performs other duties as required.

Engaged and Planned FY18 Utilization The Mission Community CaraMedics program is engaged 7 certified CaraMedics, 487 consults1

MHP achieved $910K savings on high risk Medicare Population with the assistance of Mission CaraMedics Significant annualized savings $3.3M in gross charges $910K in Medicare savings 385 IP days Savings estimate based on annualized utilization savings and Mission Hospital FY 2016 average Medicare charges, payments and ALOS.

Length of Stay: Mortality: Readmissions

End Results: 30-Day Risk-Standardized Readmission Measures Better than the National/State Rates (1/18 Nationally and 1/2 State) $1.3M Decreased Readmissions 5.46% Joint Commission Certified DSC Program Surveyed twice with No citations

Successful Practices Pulmonary Navigators/ Chronic Disease Specialists Achieving and sustaining The Joint Commission Certification Standardized Care: Care Process Model “Coding Correctly” PI Team System-wide Pay for Performance Mortality Review Transitions of Care Team PCP Focus Community CaraMedic Program

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